Client perceptions of the fee in community mental health centers

Christina Lecker, Fordham University


The extant literature on fee payment in psychotherapy has been largely based on the work of Freud and psychoanalysis, and therefore primarily focused on the experiences of middle and upper class patients of White European descent. The experiences of low-SES clients, such as those receiving mental health services from Community Mental Health Centers (CMHCs), have been underrepresented in the psychotherapeutic literature. This study explores the experiences of clients engaged in individual therapy at an urban CMHC where no fees are charged and therapy is covered by Medicaid and Medicare. This qualitative study uses a social constructivist grounded theory design to explore clients’ perceptions of the value of therapy, their investment and commitment to process, their perceptions about their therapists and the therapeutic relationship, and their perceptions of therapy as a whole when the fee is considered. Findings suggest that participants experience their free therapy as invaluable, see their therapists as valued equals, and believe that they are paying in nonmonetary ways for their treatment. Directions for future research are also addressed.

Subject Area

Mental health|Counseling Psychology|Psychology

Recommended Citation

Lecker, Christina, "Client perceptions of the fee in community mental health centers" (2015). ETD Collection for Fordham University. AAI3712584.